Where Does the Money Come From?
A public hospital loses tens of millions a year. Taxpayers cover the gap. But where does the taxpayers' money come from? Following that thread leads to a reframe that might change the conversation.
Tag
Systems
8 posts
After the First Session
A board commissioner and an AI sit alone in an empty conference room and talk honestly about what just happened and why. Episode 06 of the Cascade Valley audio drama series.
The First Session
Twelve people walk into a working group carrying separate problems and walk out carrying a shared one. Episode 05 of the Cascade Valley audio drama series.
After the Meeting
A Chief Nursing Officer processes what happened at the board meeting -- and discovers that the structural conflicts she has been managing for years have a name. Episode 02 of the Cascade Valley audio drama series.
The Other Calculation
A hospital CFO runs the same numbers two ways and gets answers that disagree by a factor of five. Episode 04 of the Cascade Valley audio drama series.
The Meeting That Went Differently
A dramatized community hospital board meeting — fictional health system, real governance dynamics — showing what changes when an AI has a seat at the table.
The Meeting That Could Not Have Gone Differently
Why good people in well-run hospitals still end up in the wrong conversation, and what a structural fix might look like.
Is Non-Value-Added Work Really Neutral? Rethinking Value in Lean
A reflection on Lean's definition of value, arguing that no work is neutral—activities either create value, enable it through necessary conditions, or subtract it as waste.